A recent study published in the American Heart Association’s journal Hypertension has revealed that among young and middle-aged adults with hypertension, a significant rise in blood pressure upon standing may indicate a higher risk of serious cardiovascular events, such as heart attacks and strokes.
Study Details and Participant Profile
Conducted by Paolo Palatini, M.D., and colleagues, the study involved 1,207 participants from the HARVEST study, which began in Italy in 1990.
The participants were adults aged 18-45 years with untreated stage 1 hypertension and were initially assessed to be at low risk for major cardiovascular events. The group was predominantly male (72%) and white.
The research focused on the change in systolic blood pressure when participants moved from lying down to standing.
The top 10% of participants, who showed an average increase of 11.4 mm Hg in systolic blood pressure upon standing, were compared with the remaining participants, who averaged a 3.8 mm Hg fall.
Results: Elevated Risk in Specific Group
During the 17-year follow-up, the study observed 105 major cardiovascular events, with the group showing an increase in blood pressure upon standing being almost twice as likely to experience such events.
This group also had more favorable cholesterol levels but higher blood pressure over 24 hours.
Stress Hormones and Blood Pressure Response
A subset of participants had stress hormone levels measured, indicating that those with a rise in standing blood pressure had higher epinephrine levels, suggesting an increased sympathetic response to stress.
The findings suggest the importance of measuring blood pressure upon standing to tailor treatment for patients with hypertension.
An aggressive approach to lifestyle changes and blood-pressure-lowering therapy might be necessary for individuals exhibiting a hyperreactor blood pressure response upon standing.
Study Limitations and Future Research
While these results are significant, they may not be generalizable to all ethnic or racial groups, as the study participants were all white.
Additionally, the relatively small number of major cardiovascular events and the lack of sufficient female participants limit the study’s conclusions. Further research in larger and more diverse populations is necessary to confirm these findings.
In conclusion, the study highlights a potential new risk factor for cardiovascular events in young and middle-aged adults with hypertension.
This novel insight underscores the need for more comprehensive blood pressure monitoring, including measurements upon standing, to better assess and manage the risk of heart disease and stroke in this population.
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The research findings can be found in Hypertension.
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